45D2118802 CLIA NUMBER - WALMART PHARMACY 10-4056

Laboratory Demographics

  • CLIA Code: 45D2118802
  • Facility Name: WALMART PHARMACY 10-4056
  • Facility Address: 10781 TOEPPERWEIN ROAD
    CONVERSE, TX
    ZIP 78109
  • Facility Phone: 479 258-6036
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RICHARD M. SCOTT
  • NPI Number: 1659398709
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2118802
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-4056
Street 10781 TOEPPERWEIN ROAD
City CONVERSE
State TX
ZIP 78109
Phone 479 258-6036
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/14/2024
Certificate Expiration Date 9/13/2026
Facility Type Pharmacy
Lab Director RICHARD M. SCOTT

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This page was last updated on: 9/29/2025